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Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people. We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure. Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease. Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola. Royal Free London NHS Foundation Trust.

The reaction of N-alkyl pyridinium iodide salts (RPy+I−, R = Me, Et, nPr, nBu) with BiI3 produced various alkyl pyridinium iodobismuthate(III) compounds, (RPy)y−3x[BixIy]. A wide nuclearity range was observed in the iodobismuthate(III) clusters when crystallized from acetone/acetonitrile: For R = Me, the dominant phase, (MePy)[BiI4]n, is a chain of edge-sharing BiI6 octahedra. Another phase, (MePy)3[Bi2I9]‧MeCN, has a face-sharing dimer of BiI6 octahedra. Five phases are reported for R = Et: (EtPy)3[Bi2I9]· 2/3 MeCN, (EtPy)3[Bi3I12], (EtPy)3[Bi3I12]·MeCN (a new V-shaped trimeric anion structural type), (EtPy)4[Bi4I16], and (EtPy)4[Bi6I22]·2MeCN. Two R = nPr phases were found: (PrPy)3[Bi2I9] and (PrPy)4[Bi4I16]·MeCN. Two phases were also found for R = nBu: (BuPy)3[Bi2I9] and (BuPy)4[Bi4I16]. Bulk synthesized products shown diffraction matches to (MePy)[BiI4]n, (EtPy)3[Bi3I12], (PrPy)4[Bi4I16], and (BuPy)4[Bi4I16], respectively. Thermal analysis of all four bulk compounds showed near complete mass loss above 300 °C.Graphic AbstractThe structures, phases, and thermal behavior of N-alkyl pyridinium iodobismuthate(III) compounds (RPy)y−3x[BixIy] (R = Me, Et, nPr, nBu) are presented and discussed.

Ritonavir and cobicistat, used as pharmacokinetic enhancers in combination with some antiretrovirals (ARVs) for the treatment of HIV, are potent inhibitors of the CYP3A4 isoenzyme. Most glucocorticoids are metabolised via the CYP3A4 pathway and iatrogenic Cushing’s syndrome (ICS), with possible secondary adrenal insufficiency (SAI), is a recognised complication following co-administration with ritonavir or cobicistat. A structured approach for identifying and managing potentially affected individuals has not been established. We systematically identified patients with ICS/SAI and found substantial heterogeneity in clinical practice across three large London HIV centres. While this significant drug interaction and its complications are now well-recognised, it is apparent that there is no standardised approach to management or guidance for the general physician. Here we describe the management of ICS/SAI in our current practice, review the available evidence and suggest practice recommendations.

HIV infection is an independent risk factor for end-stage kidney disease in HIV-positive patients of black ethnicity. Highly effective antiretroviral therapy has allowed these patients to be considered for kidney transplantation (KT). We report the outcomes of KT in a national observational cohort study. We retrospectively identified HIV-positive patients who had undergone KT up to December, 2010, through all 25 UK KT centres and major HIV clinics, and included follow-up until December, 2011. Patient characteristics, treatments, and complications were described. Patient and graft survival rates and cumulative incidence of acute rejection were estimated with Kaplan-Meier and Nelson-Aalen analyses. 35 HIV-positive KT recipients (median age 40 years, 66% male, 74% black ethnicity) were identified. At the time of KT, all patients were stable on antiretroviral therapy with undetectable HIV RNA and median CD4 cell count of 366 cells per mL. Patient survival at both 1 and 3 years was 91·3%, and graft survival was 91·3% and 84·7%, respectively. In the first year after KT, blood concentrations of calcineurin inhibitors (CNI) were frequently outside the therapeutic reference range. At 1 year after KT, the cumulative incidence of acute allograft rejection was 48%, and the median estimated glomerular filtration rate 61 mL/min/1·73 m2 (IQR 46–78). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of KT in HIV-positive patients. Co-administration of antiretroviral therapy and CNI is challenging, and sub-therapeutic CNI concentrations may contribute to the high rate of acute allograft rejection. The optimum immune suppression strategy in this population remains to be refined. King's College London.

Background: Maraviroc (MVC) has shown good efficacy and tolerability in treatment-naive and treatment-experienced HIV-1-infected patients with CCR5-tropic virus. Data on patients switching to MVC while on suppressive antiretroviral therapy (ART) are limited. The aim of this study was to evaluate patients on suppressive ART switching to an MVC-containing regimen (MVC-CR), and test the hypothesis that the switch may have an impact on T cell activation. Methods: The study population comprised 20 treated adults who started MVC with a plasma HIV-1-RNA load (viral load, VL) of <50 copies/ml. Viral tropism was assessed by V3 loop sequencing using proviral DNA from peripheral blood mononuclear cells (PBMCs). Changes in clinical and laboratory parameters were evaluated at a median of 2 and 6 months of follow-up. T cell activation was determined by measuring soluble CD30 in plasma. Results: Reasons for switching to a MVC-CR were drug toxicity and tolerability, low CD4 cell count and ART simplification. Over median 7.5 months of follow-up, 3/20 patients discontinued MVC due to severe headache, fatigue and VL rebound. A significant reduction in soluble CD30 levels in MVC-treated patients was observed during follow-up at both 2 (p = 0.027) and 6 months (p = 0.001). Conclusions: Switching suppressive ART to a MVC-CR based upon genotypic tropism prediction from proviral DNA improves tolerability. The observed impact on T cell activation warrants further investigation.

Adults, 25 years and older, now comprise greater than 50% of the student population in community colleges nationally, yet little formal research has been directed at this mature student population. This study addresses the need to have models of performance that educators can use to address the needs of the mature sector of their student population. The research developed a causal model, using path analysis based on a conceptual model developed by Donaldson and Graham. The sample comprised 2,068 mature college enrolled students, who identified their age as 25 years or older, from an ethnically diverse population, 66% female, and 55% of first generation status. The data was compiled from a recent study of 5,000 students in the Los Angeles County Community College District. The model explained approximately 30% of the variance for factors effecting positive college outcomes which, was the ratio of courses attempted to those completed with a passing grade. The study found higher academic skills in English, math and science were a strong indicator of improved outcome performance and grades. Self efficacy also had a significant relation to positive college outcomes. Being the first generation to attend college showed no relationship to completing college courses, due in part to the overall community college population having 55% first generation students. Personal problems, working full time, and having a family were not significant indicators for lower outcomes; contrary to other research these obstacles were overcome routinely by adults in order to maintain their attendance in school. An insignificant relationship between the integration activities in the classroom, and college outcomes was found. This was contradictory to the extant research and was predicated on the limited practice of integrated learning activities in the community college courses studied. Recommendations for improved college outcomes include; increasing student centered learning and faculty lead integrated activities with students sharing in classroom management. Additionally, it is recommended that to improve college success, all students be evaluated on their academic skills and be offered remediation or assistance, if needed, to achieve basic abilities in English, math and science as a basis for assuring college continuation.

The present study sought to identify a relationship between a well-established personality model and the ability to feign a psychological disorder, specifically Post-Traumatic Stress Disorder. Through the use of a population given descriptions of the disorder, financial incentives, and measures of personality, it was hoped that the nature of the relationship between the Five-Factor Model and impression management strategies would be elucidated. It was expected that factors such as Neuroticism, Conscientiousness, and Openness would be significantly related to successful feigning, as would Other Deception scores from the Balanced Inventory of Desirable Responding. Specifically, 120 undergraduates (80 females and 40 males) were asked to respond to a measure of personality (Five-Factor Inventory) and a measure of desirable responding (Balanced Inventory of Desirable Responding), as well as a trauma questionnaire. They were then asked to read a description of PTSD and then fill out the Personality Assessment Inventory as if they were attempting to successfully feign the disorder. A financial incentive was provided for the participant who most closely matched a target profile. The target profile was the mean PAI profile of a group of veterans who had received a diagnosis of PTSD and were being medically compensated. Accuracy scores for the participants were determined by the difference between the feigned profile and the target profile. Results indicated that Conscientiousness and Other Deception were significantly predictive of variance in accuracy scores. Neuroticism and Openness were not found to be significant predictors of accuracy score variance. In addition, traumatic experience as well as severity of trauma experienced were found to be significantly related to Openness. These results indicate an important first step in identifying those factors related to successful feigning of psychopathology. In addition, the results support the findings of other authors who have demonstrated a significant relationship between traumatic experience and Openness. Lastly, the use of this type of paradigm in feigning investigations was shown to be a useful methodology. Replications studies employing this paradigm would be useful, as would investigations of other disorders in order to demonstrate the robustness of these findings.

When Point State Park was planned in the late 1940s, then Gov. Edward Martin directed the state to remove and replace the Point and Manchester Bridge.